DISORDERED METABOLISM IN DIABETES - HAVE WE UNDEREMPHASIZED THE FAT COMPONENT

Despite intensive investigation, a clear understanding of the metaboli c disturbances in diabetes mellitus and their temporal relationship to each other during disease development has still not emerged. With emp hasis on non-insulin-dependent diabetes (NIDDM), three possibilities a re explored here: (1) that the insulin resistance characteristic of ob esity/NIDDM syndromes is the result rather than the cause of hyperinsu linemia, as is widely held, (2) that the linkage between hyperactivity of the pancreatic beta-cell and peripheral insulin resistance is vest ed in excessive delivery of lipid substrate from liver to the muscle b ed, and (3) that conceivably hyperamylinemia works in concert with hyp erinsulinemia in promoting overproduction of very-low-density lipoprot eins by the liver, and thus in the etiology of muscle insulin resistan ce. (C) 1994 Wiley-Liss, Inc.